Does pelvic fixation impact reoperation outcomes for neuromuscular scoliosis surgery? A 10-year matched cohort analysis.

Abstract

Purpose: To report revision surgery rates in neuromuscular scoliosis (NMS) patients undergoing posterior spinal fusion with or without pelvic fixation.

Methods: The PearlDiver database identified patients who underwent posterior spinal fusion for NMS from 2015 to 2021. Two cohorts-patients with pelvic fixation and those without-were matched for age, gender, number of levels fused, and wheelchair use. Primary outcomes were rates of subsequent posterior spinal fusion and instrumentation, and spinal wound debridement. Secondary outcome assessed subsequent posterior spinal fusion rates after further matching for wound debridement status.

Results: A total of 952 patients (476 with pelvic fixation, 476 without) were analyzed. The 10-year rate of subsequent posterior spinal fusion was similar between the two groups (6.9% pelvic fixation vs. 7.1% no pelvic fixation, p > 0.05). Subsequent posterior spinal fusion was more common in the early postoperative period (< 1 year). Wound debridement was more frequent in the pelvic fixation cohort at 10 years (10.5% vs. 6.1%, p < 0.05), with a higher proportion requiring early intervention within the first two months postoperatively.

Conclusion: No significant difference was found in subsequent posterior spinal fusion rates between the pelvic fixation group and no pelvic fixation group. The pelvic fixation group exhibited higher rates of spinal wound debridement in the early postoperative period. Our results suggest that the addition of pelvic fixation may not be necessary in every case to reduce the rates of instrumentation revision or failure. These findings represent associations within matched cohorts and provide comparative outcome data rather than guidance for individual patient decision-making.